| NPI | 1114919404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 33703) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33703) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2008-12-22 |